1245391846 NPI number — MEMORIAL HOSPITAL & PHYSICIAN GROUP HOME HEALTH

Table of content: (NPI 1245391846)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245391846 NPI number — MEMORIAL HOSPITAL & PHYSICIAN GROUP HOME HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEMORIAL HOSPITAL & PHYSICIAN GROUP HOME HEALTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245391846
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
319 E. JOSEPHINE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREDERICK
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73542-2220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-335-6631
Provider Business Mailing Address Fax Number:
580-335-6607

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
319 E JOSEPHINE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73542-2220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-335-7565
Provider Business Practice Location Address Fax Number:
580-335-7329
Provider Enumeration Date:
12/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HILBURN
Authorized Official First Name:
NATALIE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
HOME HEALTH OFFICE MANAGER
Authorized Official Telephone Number:
580-335-6631

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  7128 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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